MEDICARE: MARILYN A LOE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	71000529	IN
2	363LW0102X	Women's Health Nurse Practitioner	71000529	IN

General Provider Information

NPI Number	:	1972591295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN A LOE NP

Provider Business Mailing Address
First Line	:	7341 BRACKENWOOD CIR S
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-5438
Country	:	US
Telephone Number	:	317-722-1546
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 S MERIDIAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46225-1055
Country	:	US
Telephone Number	:	317-637-4384
Fax Number	:	317-637-4385

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	09/11/2025

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